Healthcare Provider Details

I. General information

NPI: 1922671270
Provider Name (Legal Business Name): SOJDEH SABER HAMISHEGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CARPENTER RD
ANN ARBOR MI
48108-1108
US

IV. Provider business mailing address

2650 CARPENTER RD
ANN ARBOR MI
48108-1108
US

V. Phone/Fax

Practice location:
  • Phone: 734-971-1073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301512431
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4350148059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: